Perioperative Pulmonary Atelectasis: Part II. Clinical Implications. (28th October 2021)

• Record Type: Journal Article
• Authors: Lagier, David; Zeng, Congli; Fernandez-Bustamante, Ana; Vidal Melo, Marcos F.
• Is Part Of: Anesthesiology. Volume 136:Number 1(2022)
• Page Start: 206
• Page End: 236
• Publication Date: 2021-10-28
• Subjects: Anesthesiology -- Periodicals; Anesthetics -- Periodicals; Anesthesia -- Periodicals; 617.9605
• DOI: 10.1097/ALN.0000000000004009
• Languages: English
• ISSNs: 0003-3022

Abstract

Abstract : The development of pulmonary atelectasis is common in the surgical patient. Pulmonary atelectasis can cause various degrees of gas exchange and respiratory mechanics impairment during and after surgery. In its most serious presentations, lung collapse could contribute to postoperative respiratory insufficiency, pneumonia, and worse overall clinical outcomes. A specific risk assessment is critical to allow clinicians to optimally choose the anesthetic technique, prepare appropriate monitoring, adapt the perioperative plan, and ensure the patient's safety. Bedside diagnosis and management have benefited from recent imaging advancements such as lung ultrasound and electrical impedance tomography, and monitoring such as esophageal manometry. Therapeutic management includes a broad range of interventions aimed at promoting lung recruitment. During general anesthesia, these strategies have consistently demonstrated their effectiveness in improving intraoperative oxygenation and respiratory compliance. Yet these same intraoperative strategies may fail to affect additional postoperative pulmonary outcomes. Specific attention to the postoperative period may be key for such outcome impact of lung expansion. Interventions such as noninvasive positive pressure ventilatory support may be beneficial in specific patients at high risk for pulmonary atelectasis ( e.g., obese) or those with clinical presentations consistent with lung collapse ( e.g., postoperative hypoxemia after abdominal and cardiothoracic surgeries). Preoperative interventions may open new opportunities to minimize perioperative lung collapse and prevent pulmonary complications. Knowledge of pathophysiologic mechanisms of atelectasis and their consequences in the healthy and diseased lung should provide the basis for current practice and help to stratify and match the intensity of selected interventions to clinical conditions. Abstract : Up-to-date evidence on clinical risk factors and advanced diagnostic approaches of pulmonary atelectasis are reviewed. Novel perspectives on perioperative therapeutic management based on lung imaging studies and recent clinical trials are provided to clinicians.